Pumpless arteriovenous carbon dioxide removal: A novel simplified strategy for severe asthma in children

Status asthmaticus unresponsive to pharmacotherapy is conventionally managed with mechanical ventilation, which has its inherent challenges due to barotrauma, dynamic hyperinflation and autopositive end-expiratory pressure (auto-PEEP). Extracorporeal membrane oxygenation has been used as a last resort in respiratory failure due to refractory asthma; however, it entails many complications. In contrast, arteriovenous carbon dioxide removal (AVCO(2)R) is a novel strategy that has been shown to be highly effective in adults with acute respiratory failure. Only one pediatric case series of pediatric asthma managed with AVCO(2)R have been published so far. We herein report a case of severe asthma in a 9-year-old boy who developed severe hypercapnia (Pco2 97 mmHg) and acidosis (pH 7.09) despite being on mechanical ventilation. Within 4 h of initiation of AVCO(2)R, PCo(2) drastically reduced to near-normal levels. He was discharged on day 9 of hospital stay without any complications.